HomeMy WebLinkAbout2012-00724 - water meter CITY OF ORONO * 2 0 1 z - 0 0 7 z 4 *
� - ' 2750 KELLEY PARKWAY DATE ISSUED: 07/27/2012
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 15 MYRTLEWOOD RD
PIIV : 36-118-23-33-0013
LEGAL DESC : MYRTLEWOOD
: LOT 001 BLOCK 002
PERMIT TYPE : WATER METER- RESIDENTIAL
PROPERTY TYPE : RES[DENTIAL
CONSTRUCTION TYPE : WATER METER-RESIDENTIAL
NOTE: INSEPCTIONS ARE DONE BY PUBLIC WORKS DEPARTMENT.
TO SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 245.70
JAMESWEATHER,ROBI WATER METER RESIDENTIAL HORN 68.97
15 MYRTLEWOOD RD
WAYZATA, MN 55391- MISC FEE 0.00
TOTAL 314.67
PAID WITH CASH 314.67
OWNER
JAMESWEATHER,ROB[
15 MYRTLEWOOD RD
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performcd according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if consVuction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period o�'1"8f�ays at any time after work has commenced.
The applicant is respflns�for assuring all required inspections are
requeste�m c nfor�aflce with[he State Building Code.This permit may be
revoked at an ti e for due cause.
, ��' ���� � ���� l�
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Ap�t' �t Permitee Signature Date Tssued By Si ature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A OV
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FOR CITY USE ONLY
-'���"`�� Citv of Orono /2
���O�~\� P.O.Box 66 Date Received: ����CPermit#
�,��, �`�: 2750 Kelley Parkway
�� i'� ��"� �tI Crystal Bay,MN 5�323 Approved By:(If Required):
�� �'����;,,i.�c`�� (952)249-4600
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CITY OF ORONO—WATER METER FORM
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
GENERAL 1NFORMATION
1. WATER METERS must be picked up and paid for at City Hall.
2. lf possible,fax in this application ahead of time;we will then call you and let you know we have
the water meter in stock. Fax Number: (952)249-4616. Also,you can call ahead of time to make
sure we received the fax,or to warn us that the fax is coming.
3. WATER METERS must be set and sealed by Orono Water Department (952) 249-4600,
upon completion of ineter installation.
TYPE OF PERMIT
Check All That A 1 )
❑ Residential (May Require Approval) ❑Commercial(Approval Required)
�New Meter � Additional Meter—For: � Replacement Meter
Job Site/Owner Information:
Site Address: �.5 f�r �-I� (,J�;c��Q �-,(.
� t'� ��YYlQ�(,,>Pa-��{� Mailing Address: l S M �Y ��� `'��"=�
Owner: �� ; J
c�ry: a�'v r�o z�p: S 5 3 ct l
Home Phone: ���^,��(� "U�/�� Alternate Phone:
j' ( /
Contractor Information:
Contractor: Contact Person:
Address: State License #:
City: Zip: Expiration Date:
Phone: Alternate Phone:
.
WA'I'ER METE�R PERMIT�FEES� �� �� �� �
WILL BE CAULULATED BY CITY STAFF
5/8"METER- ❑ 3/4"METER- � 1"METER-
5/8"HORN - ❑ 3/4"HORN - � 1"HORN -
� "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES llETERMINED)
I. METER FEE: $
2. HORN FEE $
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
BRaND: ��,p�-e� � �d�. � g8 350��
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SIZE: �5/S" ❑ 3/4" ❑ 1" ❑Other "
SERIAL#: III III II IIII II II IIII I IIII II II
— 1831392064
ERT HIGH#: (if applicable)
ADDITIONAL 1NFORMATION—WATER METERS
The undersigned hereby applies to the City of Orono for issuance of a water meter permit, agrees
to do all work in strict accordance with the ordinances of the City and the regulations of the State
of Minnesot ertifies that all statements made on this application are,true and correct.
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Ap,plicant: Date: �4��i ��� �g��
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Re�et F rm
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Original: 1-Address File
� Make Copies For: 1- Utility Billing Department I-Cash Drawer